In this study role of hemodynamic parameters (breast-blood-volume and breast blood-flow), obtained using T1-perfusion MRI data of breast, in the differentiation of benign from malignant breast lesions and classification of malignant lesions into different grades is evaluated. Hemodynamic parameters were also compared with the tracer kinetic parameters and semi-quantitative T1-perfusion analysis in term of grading. The high sensitivity and specificity of breast-blood-volume in differentiating between benign and malignant as well as in the grading of breast lesions (grade-I, grade-II and grade-III) were observed.
All the MRI experiments were performed at 3T whole body Ingenia MRI system (Philips Healthcare, The Netherlands) using a 7 channel biopsy compatible breast coil. Fifty female subjects, 15 benign and 35 malignant (5 grade-I, 19 grade-II, 11 grade-III and) with breast lesions, were scanned for MRI data.
MRI Data acquisition: After a localizer, 2D T1-Weighted(W), T2-W, and PD-W images with and without fat suppression were acquired using turbo spin echo pulse sequence for multiple slices covering entire breast tissue. FOV=338×338mm2, slice thickness=3mm and acquisition matrix 452×338 were used for T1-W, T2-W and PD-W images. In this study, TR/TE=2821ms/30ms, TR/TE=2823ms/100ms and TR/TE=557ms/10ms for PD-W, T2-W T1-W images respectively. Contrast (Gd-BOPTA (Multihance, Bracco, Italy)) enhanced T1-perfusion MRI was performed using a 3-dimensional fast field echo sequence (TR/TE=3.0ms/1.5ms, flip angle=12o, matrix size=228*226, acquisition time 222seconds, 40 dynamics and 5.4 seconds temporal resolution).
Data Processing: Data were processed using in house written programs in MATLAB 2014a. After pre-processing, T1-perfusion MRI data were analyzed using semi-quantitative approach5 (kinetic curve types I, II or III), generalized tracer kinetic model5(Ktrans, Ve, Vp and Kep) and first pass analysis11 (hemodynamic parameters). Relative quantification of breast blood volume (BBV), leakage corrected BBV(BBVcorr) and breast blood flow(BBF) was performed by placing an ROI in the normal fibro-glandular tissue from the contra-lateral or same side of the breast. Receiver operating characteristic (ROC) curve, Chi-squared, and T-test were used for statistical analysis.
1. Elston C, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410.
2. Robbins P, Pinder S, de Klerk N, et al (1995) Histological grading of breast carcinomas: A study of interobserver agreement. Hum Pathol 26:873–879.
3. Yang S-N, Li F-J, Chen J-M, et al (2016) Kinetic Curve Type Assessment for Classification of Breast Lesions Using Dynamic Contrast-Enhanced MR Imaging. PLoS One 11:1–10.
4. Zhen-Shen Ma et al. “Quantitative analysis of 3-Tesla magnetic resonance imaging in the differential diagnosis of breast lesions” Experimental and Therapeutic Medicine 9: 913-918, 2015.
5. Khouli RH El, Macura KJ, Kamel IR, et al (2011) 3 Tesla Dynamic Contrast Enhanced Magnetic Resonance Imaging of the Breast: Pharmacokinetic Parameters versus Conventional Kinetic Curv. AJR AM J Roentgenol 197:1498–1505.
6. Fusco R, Filice S, Granata V, et al (2013) Can semi-quantitative evaluation of uncertain (type II) time-intensity curves improve diagnosis in breast DCE-MRI. J Biomed Sci Eng 6:418–425.
7. Goto M, Ito H, Akazawa K, et al (2007) Diagnosis of breast tumors by contrast-enhanced MR imaging: Comparison between the diagnostic performance of dynamic enhancement patterns and morphologic features. J Magn Reson Imaging 25:104–112.
8. Fw F, Jd A, Rm S, Jc W (1993) Differentiation of benign from malignant breast masses by time intensity evaluation of contrast enhanced MRI . Magn Reson Imaging 11:617–20.
9. Macura KJ, Ouwerkerk R, Jacobs M a, Bluemke D a (2006) Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. RadioGraphics 26:1719–1734.
10. Snekha Sehrawat , Pradeep Kumar Gupta , Meenakshi Singhal , Rakesh Kumar Gupta , and Anup Singh(2017). Quantification of tracer kinetic and hemodynamic parameters of human breast tumor and fibro-glandular tissue using DCE-MRI data. Proc. Intl. Soc. Mag. Reson. Med. 25 (2017).
11. Singh A, Haris M, Rathore D et al.. Quantification of physiological and hemodynamic indices using T1 dynamic contrast enhanced MRI in intracranial mass lesions. J. Magn. Reson. Imaging 2007;26:871–880. doi:10.1002/jmri.21080.